Anatomy Lesson #38: “Outlander Tears” or “Why, oh Why, do We Cry?”

Greetings anatomy students! Flurry over the Outlander premier has abated and S.2 is well underway so it is time for another anatomy lesson. Yay! The bell has rung and class is in session! This anatomy lessons turns our attention to the poorly understood act of emotional crying.

As always, we’ll use Starz images to set the stage for our lesson. Beginning with S.2 opening theme, we are greeted with excellent images of emotional weeping. Claire’s tears flow as she desperately pleads with Jamie after his torture at the hands of the Bloody Blackguard (Starz episode 116, To Ransom a Man’s Soul)!

Claire cry 04

Her tears flow almost unabated through the first half of Starz episode 201, Through a Glass, Darkly. The episode begins with Claire separated from Jamie and her pain is palpable as she shrieks her rage to the heavens (Starz episode 201, Through a Glass, Darkly)!

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Her fury is quickly followed with helpless tears of loss and grief as she collapses amid the towering stone monoliths capping Craigh na Dun!

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Wandering the road to Inverness, Claire meets a kindly Scotsman. She collapses in desperate sobbing after he reveals, yes indeed, the British won the Battle of Culloden! We empaths shed tears along with our beautiful, courageous heroine!

Claire cry 01

This quote from Diana’s Dragonfly in Amber book adds depth to Claire’s desolation:

I woke three times in the dark predawn. First in sorrow, then in joy, and at the last, in solitude. The tears of a bone-deep loss woke me slowly, bathing my face like the comforting touch of a damp cloth in soothing hands. I turned my face to the wet pillow and sailed a salty river into the caverns of grief remembered, into the subterranean depths of sleep.

Claire cry 05

Time to start this tearfilled lesson (sob) with a brief anatomical overview. Unless one suffers from an unfortunate condition such as dry eyes (keratoconjunctivitis sicca), tears flow under three different conditions: base-line tear production, non-emotional tearing, and emotional weeping. Regardless of the cause, all three types involve lacrimation (Latin, lacrima, meaning tear), the production of tears. So, sharpen your scalpels and let’s dissect each type of tear, one-at-a-time.

Base-line Tears: We learned in Anatomy Lesson #30, “Aye, Eye – The Eyes, Part 2,” each eyeball is equipped with a lacrimal apparatus which produces and drains tears. That apparatus includes the following features.

In the upper outer corner of each bony orbit (Anatomy Lesson #30, “Aye, Eye – The Eyes, Part 2,”) lies the small but powerful lacrimal gland (Image A). Most of the gland lies inside the bony orbit but a small part projects into the upper eyelid. Small ducts (channels) pierce the conjunctiva (transparent membrane) and convey the secretion onto the eyeball surface.

The lacrimal gland is designed to continuously secrete (discharge) the aqueous (watery) part of the tear film which bathes the surfaces of cornea and conjunctiva (Anatomy Lesson #30, “Aye, Eye – The Eyes, Part 2,” and Anatomy Lesson #31, Aye for an Eye – The Eye, Part 3). Although their roles differ, fibers from both sympathetic and parasympathetic divisions of the autonomic nervous system (the part we don’t control) supply the gland (see Anatomy Lesson #32, “A Real Eye Opener – The Eye, Part 4). Working together, parasympathetic fibers induce secretion and sympathetic fibers control blood flow.

The tri-laminar tear film (Image A) is composed of an inner mucous (adj.) layer produced by mucous cells of the conjunctiva, a middle aqueous layer produced by the lacrimal gland, and an outer oil layer produced by tarsal glands of the eyelids (Anatomy Lesson #29, “The Eyes Have It! – The Eyes, Part 1”). The tear film represents basal tearing and it is critical to the health of exposed eye surfaces.

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Image A

The tear film is continuously renewed and then drained by the following structures. Closure of the eyelids moves the tear film toward two small openings, the lacrimal puncta (pl.), at the nasal end of each eyelid (Image B – lacrimal apparatus of right eye). Each punctum (find yours) drains into one of two lacrimal canaliculi, tiny channels which empty into a reservoir, the lacrimal sac. From the lacrimal sac, tears traverse the nasolacrimal duct and drain into the ipsilateral (same side) nasal cavity. Remember, each eye has its own lacrimal apparatus.

The tear film doesn’t just give Jamie his sparkling bonny blue orbs; rather, it serves three important purposes:

  • Protects and lubricates exposed surfaces of the eyeball.
  • Washes away foreign particles.
  • Reduces the risk of eye infections (antibacterial).

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Image B

Non-Emotional Tearing: Also known as reflex tearing, non-emotional tear production is a response to eye irritants. If the exposed eyeball is insulted, the lacrimal glands are stimulated to produce a flood of tears which overwhelms the lacrimal drainage system. Having no adequate outlet, they escape the eyelids and run down the face.

What are the causes of non-emotional tearing? Well, foreign bodies, objects that enter the eye from outside the body, are the most common cause. Although intuitively obvious, here are some important clues that a foreign body may have taken up residence in your eyeball:

  • Pressure
  • Discomfort or pain
  • Sensation of something “in the eye”
  • Extreme tearing (yes!)
  • Photophobia (pain or discomfort with light exposure)
  • Excessive blinking
  • Redness or bloodshot conjunctiva (image C)

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Image C

And just so you know, the following foreign objects are the most common causes of non-emotional tearing:

  • eyelashes
  • dried mucus
  • sawdust
  • dirt
  • sand
  • cosmetics
  • contact lenses
  • metal particles
  • glass shards

Those who read Anatomy Lesson #29, “The Eyes Have It! – The Eyes, Part 1” may recall examples of the now-popular eyelash jewelry, including among other delights, crystals glued to the eyelashes! Who thought that was a good idea? Well, if one is not verra careful, these fake jewels can wreak havoc as foreign bodies! Case in point, crystals float on the tear film overlying conjunctiva and cornea (Image D). These were likely applied to the upper surface of the lower eyelashes. The glue failed and the crystalline escapees drifted onto the eyeball surface.

Understand that if the conjunctiva is intact, objects deposited on the front of the eyeball cannot get lost behind it (Anatomy Lesson #30, “Aye, Eye – The Eyes, Part 2). They can, however, scratch the cornea and cause infection so foreign bodies in the eye should be resolved STAT!

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Image D

Then, there are really dangerous foreign bodies such as metal shards (Image E) that pierce the transparent conjunctiva and embed in the sclera (Anatomy Lesson #32, “A Real Eye Opener – The Eye, Part 4). Such objects can scratch the inner eyelids and cause infections. Och, I bet that hurts!

Protective eyewear can help prevent such injuries and should certainly be worn if working with:

  • saws, hammers, grinders, lawn mowers, and other power tools
  • dangerous or toxic chemicals

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Image E

Non-emotional tearing also follows exposure to irritating substances such as the whiff of onions (Image F) or noxious agents such as insecticides, perfumes, detergents, smoke, dust, etc.

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Image F

Well then, fair’s fair (Image G)! Too gruesome? If yes, why are ye watching/reading Outlander? Hee, hee.

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Image G

Speaking of noxious substances, if an across-the-counter product splashes into the eye, you can immediately relieve discomfort and assist tear formation by washing the eyeball. Yes, you read it correctly! Every science laboratory worth its salt sports an eye wash station as part of its safety equipment. Since few homes have such an apparatus, you can use a sink faucet or garden hose. Run a stream of cool water (NOT hot!) from the tap or hose. Open the irritated eye and turn head so the affected eye is DOWN. Let the water run across the eyeball from the nose towards the ear (Image H). Do NOT run water from the ear towards nose! Why? Because the irritant will flow into the lacrimal drainage structures and nose. Voila, now the problem is compounded!

Flush the eye for 15 minutes! Yes your water bill will skyrocket, but the irritant must be thoroughly diluted. Depending on the substance (think acids, lye, etc.), hie to the nearest urgent care facility or call EMT/fire department. In the meantime, wash!

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Image H

Finally, if something splashes into both eyes, use a garden hose or a faucet spray nozzle. Look down and widely opening both eyes, allow water to flush them simultaneously. Do not turn the head to either side.

The following is an informative and well-done Youtube video that includes images of how to deal with splashes involving both eyes. Note that although it starts with showing a one eye splash, later it demos both eyes involvement.

Emotional Tearing: Now, we get to the nitty-gritty! Also known as psychic tearing, this is the same as crying, the shedding of tears trigger by emotions. Crying synonyms include weeping, wailing, sobbing, whimpering, squalling, mewling, and bawling. Humans cry if we feel grief, stress, sadness, happy, overwhelmed, pleasure, anger, and suffering. But, the bottom line is, scientists understand very little about why emotions provoke human crying!

Again, Outlander S.2 comes to our rescue: Rage, grief, and despair fuel Claire’s tears in Starz episode 201, Through a Glass, DarklyBut, in the same episode, Frank shares with us fine examples of emotional tears!

Tears of gratitude – Claire has finally returned to him. He doesn’t care who she bedded during her Highland gad-about, nothing could ever change the way he feels about her! No way, Jose!

Frank tears 01

Tears of wonder – After Claire reveals that she has a “bun in the oven”, Jack, oops, I mean Frank, is thrilled and responds with more pop up tears. Oh, my, he is delighted,  desperately happy and “over the moon”! Ah, erm…wait! How could such a miracle happen because his doctor told him that …

Frank tears 02

Tears of fury – What? That red-haired bastard (weil, son of a bastard) knocked up his beloved Claire? Who the hey does that guy think he is? And, presto, just like that, Franks’s tears of joy turn into rivulets of rage! So much for his “nothing you could ever do” speech.

Recall not-her-name Sally and her alley cat friends (Starz episode 108, Both sides Now)? Frank came very close to sharing the same black-jack knuckle sandwich with Claire! Fist of fury!

In rapid succession, Frank delivers a wallop of emotion-ladened tears just in time for this lesson. TY, Frank. Much obliged!

Frank tears 03

Back to our lesson: many of us ken that newborns wail without tears. Their nascent lacrimal glands produce just enough baseline tears to moisten their eyeballs. Somewhere between 1-3 months the lacrimal glands develop enough to shed tear droplets in response to physical discomfort (Image I).

Around puberty, tears from emotional pain usually overtake those from physical discomfort. Gradually, with age and experience, people add moral crying in response to acts of courage and self-sacrifice or to symbols such as the flag of one’s country or to the sound of bagpipes (my personal favorite)!

emotional crying

Image I

Now, scientists do have insights about how tears and emotions are linked. Emotional crying is a complex secretomotor phenomenon characterized by the shedding of tears sans ocular irritation. The lacrimal gland is linked to the limbic system (Image J), part of the brain that processes emotions. The limbic system (waaaay too complex for this lesson) is hard-wired into the autonomic nervous system/ANS (the part you cannot voluntarily control). With the proper emotional trigger, the limbic system stimulates the ANS to release the neurotransmitter, acetylcholine, a wee molecule which then stimulates the lacrimal gland to shed emotional tears. Ergo, emotions interpreted by the limbic system activate the ANS which releases acetylcholine which turns on the water taps! Voila, we sob with feeling! Pretty remarkable.

Limbic System KLS edited

Image J

What we don’t understand is why do strong emotions cause us to cry? What is the purpose of emotional tears? Well, there are lots of ideas, one dating back more than 2,000 years.

Greek philosopher and scientist, Aristotle, posited that tears are waste products like urine and therefore, discarded by the body (Image K): “That they are of one nature is plain to the taste.”

Take comfort, Jamie! Claire isna the only healer to taste urine (deferred to a future lesson). Truth be told, dedicated physicians used to routinely taste their patient’s urine. Talk about the call of duty. Pitooey!

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Image K

Here’s a good one…in the 1940s, American psychoanalyst and physician, Phyllis Greenacre, proposed that female weeping is a sign of penis envy and the way a woman can imitate a man urinating. A hypothesis to which I offer this scientific response: Snort!

Others have proposed that tears, like urine production, cleanse the blood. However, the average cry yields only about 20 tear droplets or the equivalent of 1 ml, a totally inadequate amount of fluid loss to alter blood composition.

Some suggest that crying purges the body of harmful chemicals produced under duress. Forty years ago, a biochemist found that emotional tears were richer in protein than non-emotional tears. Unfortunately, others failed to replicate his findings so they lost momentum. A basic tenet of scientific research is that independent laboratories must be able to replicate another’s results…. an excellent check and balance system.

However, later studies have shown that emotional tears contain elevated levels of prolactin (cuddle hormone), adrenocorticotropic hormone (induces adrenal cortex to release the stress hormone, cortisol), and leucine enkephalin (a natural painkiller). So, there may be merit to the idea of emotional purging. Verra complex, are our emotional tears!

Along a similar vein, Darwin proposed that in addition to lubricating the eyeballs, tears “serve as a relief to suffering,” and the idea that crying is cathartic remains viable but unproven. General wisdom suggests that emotional crying does make one feel better. But, why? Well, if misery is short lived, our mood may lighten by the time we finish a good cry. Or, in the midst of despair, something wonderful might happen to completely alter one’s mood such that eyes spout tears of joy!

Intriguingly, some researchers consider emotional crying as a social signal that a person needs nurturing; a sort of primal “shoutout” for help. One interesting study showed pictures of tearful faces to subjects. Within 50 milliseconds (.05 sec.) test subjects reported a boost in feelings of empathy and friendship towards people shown in such images. This very interesting hypothesis awaits further investigation.

Here’s some Outlander proof that social signals work: a mess of fans were ready, willing, and able to comfort that ginger-haired laddie as he wept at Wentworth Prison (Starz episode 115, Wentworth Prison)! Yep!

Jamie tears 02

Here’s another fascinating aspect of emotional tearing. Boys and girls cry with equal frequency until puberty when something complex happens. In Western cultures, boys are conditioned to restrain tears such that women cry twice (one study says 5x) as frequently as men. Biology may also play a role as male puberty is marked by increased testosterone production and some studies hint that this male hormone helps suppress emotional tearing.

Even more interesting, in some social settings such as sports, male displays of feeling such as hugging, cheering, and crying are OK; perhaps because people expect emotions to run high at sporting events. Consider Mario Balotelli, a world class footballer (soccer in US) for team Italy.  At the 2012 Euro final, Spain defeated Italy and Mario wept with deep regret (Image L). Apparently, this emotional display did nothing to hinder his career and may have helped it.

Finally, it seems that emotional crying in men can be downright desirable. Studies show that if powerful men display controlled weeping in response to sad or challenging situations, they are perceived as more competent than men who do not. Consider the lion-hearted WW II British PM, Winston Churchill, who has been dubbed the most tearful politician of all time!

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Image L

Another consideration: scientists agree that animals shed tears to protect their eyes but also posit that humans are the only animals that cry based on feeling. Now, I ken that this supposition is bound to rouse some mighty powerful responses from readers who swear their pets display emotions (I’m pretty sure mine do)!

Charles Darwin wrote in The Expression of the Emotions in Man and Animals that keepers of Indian elephants at the London Zoo claim their charges shed tears of sorrow (Image M). And, social media is rife with anecdotal reports that, indeed, animals do demonstrate sadness.

However, science can barely evaluate human emotions much less interpret the emotional status of animals. Understand that this scientific position makes psychic weeping in animals neither true nor false, just not provable at this point in time.

elephant tears

Image M

As if this isn’t enough of teary stuff to contemplate, photographer Maurice Mikkers has recently photographed evaporated human tears and found that no two are alike in salt and mineral deposition (Image N)! ”Every tear is as unique as a snowflake,” writes Maurice. The significance of this fascinating finding awaits further studies.

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Image N

So, one may safely surmise that the scientific jury is still out on why humans engage in emotional crying. Love it or despise it, crying appears to be a complex, multifactorial response which is crucial to our well-being! Emotional tears are potent symbols of who we are as individuals and as members of the collective whole (such as Outlander fans), celebrating our deepest connections to the world.

Sniff! Now that Outlander has returned to Starz, where is my box of tissues? Awaiting new episodes, but thus far, my favorite emotional tears are those shed by Jamie after Claire declares, “take me home to Lallybroch” (Starz episode 111, The Devil’s Mark). Wake up lad! She’s baaaaack!

Diana’s words from Outlander book!

He slept on his back, as he usually did, hands crossed on his stomach, mouth slightly open. The last rays of daylight from the window behind me limned his face like a metal mask; the silver tracks of dried tears glinted on golden skin, and the copper stubble of his beard gleamed dully…I kissed his cheek, damp and salty.

Jamie tears 01

I close this lesson with an amateur’s haiku poem in honor of Jamie’s emotional weeping:

Ode to Jamie’s Tear

Single tear slips free

Silent, salty and serene…

Pledge of endless love

A deeply grateful,

Outlander Anatomist

Photo creds: Starz, Maurice Mikkers – photographer of human tears (Image N – 27 Feb. 2016, New Scientist), www.dailybhaskar.com (Image D), www.emedicine.medscape.com (Image E), www.en.wikipedia.org (lmage J), www.evolutionaryparenting.com (Image I), www.hubpages.com (Image C), www.huffingtonpost.com (Image M), www.huntingtoneyecare.com (Image A), www.pickchur.com (Image G), www.inthestands.co.uk (Image L), www.studyblue.com (Image B), www.thekoreanforeigner.blogspot.com (Image F), www.vikasacharya.wordpress.com (Image K), www.youtube.com (Image H)

Fun Fact – risorius

risorius

Anatomy def: narrow band of muscle fibers arising from the fascia over each masseter muscle, inserting into tissues at the corners of the mouth, and acting to retract the angles of the mouth.

Outlander def: paired, strong muscles pulling back the corners of the mouth as in a grin, or a grimace to menace wary victims!

Learn about the risorius muscle in Anatomy Lesson #13: “Frank and BJR” or “Face Off.”

Read about BRJ’s face in Outlander book:

Whatever this man’s cousin looked like, the man himself might have been Frank’s brother. There was the same lithe, spare build and fine-drawn bones; the same chiseled lines of the face; the level brows and wide hazel eyes; and the same dark hair, curved smooth across the brow. But this man’s hair was long, tied back from his face with a leather thong. And the gypsy skin showed the deep-baked tan of months, no, years, of exposure to the weather, not the light golden color Frank’s had attained during our Scottish holiday.

See BJR’s risorii muscles in action as he glowers at Claire (Starz episode 101, Sassenach)!

Risorii muscles are likely the bases for the vertical skin creases commented upon in a recent interview with Tobias Menzies.

And, for the truly dedicated, the December 2015 issue of Smithsonian showcases an interesting article “Face to Face” (pp. 46-51) about software being developed to decode facial expressions and change the way we interact with our devices and each other. No more emoticons?  Gasp!

A deeply grateful,

Outlander Anatomist

“Jamie’s Chin – Manly Mentus”

A hearty hello to valued anatomy students! Today’s Anatomy Lesson #26 is the Chin. A few months back several students asked for a lesson on Jamie’s chin so here it is. Serendipitously, this past week I also followed an avid Facebook discussion focused entirely on Jamie’s chin. Being a demure lady (snort!) I canna repeat the ideas that were posted; suffice it to say they were imaginative! Mmmphm. And, as Herself mentions the chin often in her Outlander books, let’s go!

English idioms about body parts are always fun to consider. Interestingly there are not many about the chin and most are concerned with either stamina or aggression: keep your chin up, take it on the chin, lead with the chin, catch it on the chin, wag one’s chin and to quote a particular portly pig (and some rappers) “not by the hair of my chinny chin chin!”

Right off the bat, let’s get the most important chin issue resolved and out of the way: Jamie’s chin is the strongest, handsomest and most manly mentus in filmdom (Starz episode 102, Castle Leoch)! Gah! Not sure I can keep me train of thought, but I’ll try!

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So verra delighted and deeply (ha ha) grateful that this man was chosen to play the King of Men! Even English nobility shares this opinion. Consider the Duke of Sandringham swiping his fingers across Jamie’s most excellent chin (Starz episode 110, By the Pricking of My Thumbs):

“Alas, my servants are chosen for their beauty, not their belligerence.”

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“You, of course, contain within you a sublime combination of the two!”

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This smarmy old rascal is spot on: Jamie, you are indeed a sublime blend of beauty and belligerence! Best you look askance at the Duke and his roving fingers; Claire willna like him fondling yer chinny chin chin! Sandringham invokes the lyrics from “You Did It” (My Fair Lady): “Oozing charm from every pore. He oiled his way around the floor.” Grrrreasy!

Now for chin anatomy: More than 200 years ago, the German physician, naturalist, physiologist and anthropologist, Johann Friedrich Blumenbach (1752 – 1840) declared that the chin is a uniquely human feature. Nowadays, most naturalists agree that elephants (Photo A) and perhaps two other mammals have chins but few species other than humans can lay claim to this body part.

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Photo A

A few scholarly circles hotly debate, why do we have a chin and what is its purpose? One cool idea posits that the human chin emerged due to speech and mastication (chewing) patterns. Indeed, computer models show that mechanical stress relating to muscle pull could contribute to chin development.

Another proposed reason for the human chin is sexual dimorphism, the different appearance of a body part between the genders. Typically, female chins are smaller and rounder and male chins are bigger and squarer. Such differences, it is argued, contribute to attractiveness and augment mate selection. And, don’t our Claire and Jamie demonstrate chin sexual dimorphism to a T (Starz episode 101, Sassenach)?

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Alas, the June 2015 Smithsonian reports that the chin didn’t develop to make us swoon nor to accommodate speech or distribute the stress of chewing. Rather, newest thinking declares the chin is the by-product of a shrinking face: over the eons, the face has decreased in size and tilted inward which in effect pushes chin and jaw outward. As for me, I prefer the sexual rif, thank you very much!

More chin anatomy: the mentus (Latin meaning chin) has several topographical features. First, the chin (Photo B –black arrow) and nose are typically the most forward projecting parts of the face. The chin has a bony base but the fleshy, moveable tip is the chin pad. From the point of the chin a pair of bony horizontal ridges project backward (Photo B – green arrow) each ending as a bony angle (Photo B – purple arrow). Between the lower lip and the chin is a horizontal skin groove, the mentolabial sulcus (Photo B – blue arrow).

Try this: What, there’s work to do already? Yep! Grip and wiggle your chin pad. Next, find your mentolabial sulcus, left and right horizontal bony ridges and bony angles. Very nice and good for you!

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Photo B

The projecting point of the mandible (Latin meaning jawbone) provides the bony foundation for the chin. The mandible arises during fetal life where it develops as right and left halves joined in the midline by a thin plate of fibrocartilage (Anatomy Lesson #24). The paired mandibular halves persist until the second year of life when the joint ossifies into a vertical bony ridge, the mandibular symphysis (Photo C – drawing of newborn skull).

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Photo C

During childhood, the chin persues the adult form as a midline triangular-shaped mental protuberance flanked on each side by a mental tubercle (Photo D). In the midline above the protuberance lies the unpaired bony ridge, the mandibular symphysis or symphysis menti (Photo D – black arrow).

Try this: Once again locate your mentolabial sulcus. Move one fingertip just below the sulcus and wiggle it back and forth. Do you feel a faint ridge? This is your symphysis menti. Move the finger downward to the bony tip. This is your mental protuberance. Now move your fingers to the left and right; do you feel a pair of small bony bumps? These are the mental tubercles. Well done!

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Photo D

Let’s consider more about the mandible (Anatomy Lesson #11 and Anatomy Lesson #13), the parent bone of the mentus. The mandible (unpaired after two years of age) is the strongest, largest and lowest bone of the skull and is its only moveable bone. It has a U- or V- shaped body (Photo E) expressed as the lower bony ridges mentioned above. The body ends posteriorly as the bony angles of the mandible (Photo E – only left side labelled). Jutting upward and backward from each mandibular angle is a strong bar of bone, the ramus. In the midline are bony features of the chin as described above. Lastly, the mandible has an upper alveolar part (Photo E) that serves as a receptacle for 16 adult teeth which in the best case scenario includes: four front incisors, two canines (BJR’s dog teeth – black arrows), four premolars and six molars.

Try this: Palpate the body and angles of your mandible. Look in a mirror, open your mouth and find incisors, canines, premolars and molars (if present). If your mouth is too dark to clearly see the teeth, shine a flashlight into the mirror; the light reflects back into your mouth and nicely illuminates that inner sanctum!

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Photo E

Each mandibular ramus ends in two bony projections: a condylar process the head of which articulates with a socket in the temporal bone at the TMJ (temporomandibular joint) and the sharp coronoid process (Photo F) onto which attaches a muscle of mastication (see below). On the inner surface, each ramus has an opening, the mandibular foramen, for passage of a nerve. On the outside of the chin are left and right mental foramina (pl.) which also transmit nerves.

 

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Photo F

Warning: The next image (Photo G) shows a deep dissection of the head and neck. Please skip if you find such images challenging. Three important nerves on each side of the face are pertinent to our discussion. The paired mandibular nerves (branches of Cranial Nerve V) exit the skull deep to each cheek bone (zygomatic arch – Anatomy Lesson #9). Each mandibular nerve produces left and right inferior alveolar nerves or IANs that enter the mandible via the mandibular foramina (shown in Photo F) to supply sensation to the lower teeth. Ouch! Yes, IANs are the culprits that transmit tooth pain! Along the way, each IAN gives off a mental nerve which exits via its respective mental foramen and provides sensation to lower lips, gums and chin. Bet Jenny didna ken that a nerve was named after her kindly brown-haired laddie!

Try this: Straddle your mentus with thumb and forefinger. Place them about the same vertical level as your canine teeth. Press down gently until you feel slight hollows and a tingle. These are your mental nerves exiting the mental foramina.

Figure0067A inferior alveolar nerve KLS edited

Photo G

A discussion of the chin is incomplete without considering associated muscles. A whopping 28 muscles attach to the mandible – yes, that’s 14 muscles per side! I won’t name them all. Muscles that attach to the mandible (see below) act on seven different head and neck regions. Suffice it to say that each side of the mandible has four muscles for chewing, one moves the cheek, three move the lower lip, one wrinkles neck skin, three move the tongue and two help us swallow. As if this weren’t enough, several of these muscles aid in speech by moving lips, tongue and hyoid bone (Anatomy Lesson #12). Whew! The mandible (and its chin) truly is a workhorse for head and neck muscles.

Three of the 14 muscle pairs mentioned above are easily demonstrated. Each mentalis muscle arises from the mental protuberance and inserts into the lower lip (Photo H). As they contract, the lip elevates and protrudes as in a pout; simultaneously, the skin of the chin wrinkles. They also add bulk to the chin pad. Each masseter muscle arises from the zygomatic arch (Photo H – black arrow) and inserts into body and angle of the mandible; contraction closes the jaw. The temporalis muscles are the third pair of muscles for today. These fan-shaped muscles arise from the sides of the skull and insert onto the coronoid processes (shown in Photo F) of the mandibular rami. Contraction closes and retrudes (pulls backward) the mandible.

Try this: Return to the mirror and wrinkle your chin-skin. Congrats! You just activated your mentalis muscles. Next, place your fingers in the hollow of each temple; close your teeth and retrude (pull back) the mandible. You should feel tension in each temporalis as they contract. Finally place fingertips just anterior to each mandibular angle. Bite down and feel the masseters tense as they close the mandible.

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Photo H

Are these muscles at work in Outlander? Oh, to be sure! Geillis offers us a wonderful visual as she interrogates Claire before sentencing at the witch’s trial (Starz episode 111, The Devil’s Mark)! Why are you here in Scotland (English lassie has no idea) and when will you stop lying (tell the truth, the whole truth and nothing but the truth!)? Here, Geillis opens her mandible using muscles of mastication (lateral pterygoids) that we have yet to learn and are not visible from the skin surface. With the mandible widely opened, the masseter is pulled taut (green arrow) and the temporalis is stretched creating a hollow at the temple (blue arrow). Try it yourself; it works!

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Next, Geillis closes her mandible using the powerful masseter muscles (black arrow). This wild wily witch needs some answers before she becomes kindling at her own personal bar-b-que!

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Mentalis muscles are at work “Down by the Riverside” as Sassynach and Big Red One go at it hammer and tongs! After Claire wounds an astonished Jamie with her sharp 20th century tongue, she feels verra sad (Starz episode 109, The Reckoning). This sassynach is the best chin-skin-wrinkler and lower-lip-pouter in the whole of Scotland! Yep, her mentalis muscles are working hard here!

ep-109-Claire-mentalis-01-KLS-edited

Finally, no chin discussion would be complete without considering chin shape: is a chin smooth, dimpled, creased, clefted or using urban-speak, the awful “butt chin” (who dreamed that one up)? All these chin shapes are considered normal variants but, interestingly, the cleft chin is most common in people of European descent.

Science teachers may use the cleft chin as an example of a dominant genetic trait. But like the earlobe (Anatomy Lesson #24), the broad range of chin types should not be observed if simple dominant-recessive inheritance is at work. Other possible explanations for chin shapes include variable gene penetrance but this is beyond our present discussion.

Humans have long favored chin dimples as a mark of beauty. In Persian literature, the chin dimple is a “well” into which a poor lover falls and becomes trapped! Because a forest of growth covers the chins of most Starz Highlanders (the lads, no the lassies!), assessing their chin dimples is a challenge.

Consider dear Dougal whose chin and mandible are thickly furred. In honor of my good friend Jo Kc and the myriad of other Dougal fans, this image is for us! Here, big bad bro Colum abuses Dougal with names like “half-wit” and “numbskull” (Starz episode 110, By the Pricking of My Thumbs). Please employ your virtual imagination to identify as many chin and mandibular features as possible. Enjoy!

ep 110 Dougal chin KLS edited

Clean-shaven Highlanders are more rare than a wild haggis but here is that cutie, Willie; his is an excellent example of a smooth chin (Starz episode 114, The Search). Nice eyes, laddie!

ep 114 Willie chin KLS edited

Do ye like Claire’s wee but thoroughly charming chin dimple? Her chin enjoys one degree of separation from the smooth type. Here, she implores her husband: “Come back to me James Frasier” (Starz, episode 110, By the Pricking of My Thumbs). Oh, no! That clever, cunning Colum is sending her darling Jamie away!

ep 110 Claire chin KLS edited

Moving two degrees of freedom from a smooth chin, Jamie’s awesome chin crease sends many a heart into cardiac arrest (Starz episode 113, The Watch)! Ye can see it well despite the bit o’ scruff that typically adorns his manly mentus. Herself writes about this in Outlander book:

“Good.” He loosened his grip and turned me to face him. At close range, I could see the bristle of auburn stubble on cheek and chin. I brushed my fingers across it; it was like the plush on an old- fashioned sofa, stiff and soft at the same time.”

Ummm, gulp!

ep 114 Jamie chin KLS edited

Oh, what? You canna see Jamie’s chin crease clearly enough? Okay, here is the only image of a clean-shaven Jamie I can find in the episodes (Starz opening credits). Do ye ken the crease now? Of course ye do. Won’t be sleeping tonight? Oooh, so sorry! Join the bazillions of fans who L-O-V-E Jamie’s chin!

into-Jamie-shaven-chin-KLS-edited

Okay folks let’s finish this lesson with a short pop quiz using matching questions. Here are six numbered structures followed by six lettered photos with arrows indicating the body part. Match the named structure with the body part. Answers appear at the end. Ready. Set. GO!

STRUCTURE:

  1. Mentolabial sulcus
  2. Angle of mandible
  3. Body of mandible
  4. Mentus
  5. Mentalis muscle
  6. Masseter muscle

photo-A

A

photo-B

B

photo-C

C

photo-D

D

photo-E

E

photo-F

F

ANSWERS:

1 = B   (Starz episode 110, By the Pricking of my Thumbs)

2 = C   (Starz episode 108, Both Sides Now)

3 = F   (Starz episode 110, By the Pricking of my Thumbs)

4 = E   (Starz episode 111, The Devil’s Mark)

5 = D   (Starz episode 111, The Devil’s Mark)

6 = A  (Starz episode 109, The Reckoning)

Hope you did well on the matching quiz. Let’s close this anatomy lesson with a big old chinny chin treat!

Ode to Jamie’s Chin

Jamie Fraser has a chin, a manly chin has he.

His tender fuzz will give you a buzz

And maybe two or three!

Dream of petting Jamie’s chin and leave a kiss or two.

It’ll grieve you much, but do not touch

Lest his wife come into view!

Claire Fraser is a lucky lass but a jealous wench is she.

Dinna touch his chin or she’ll slap your skin

into eternity!

 yum

(Starz episode 112, Lallybroch)

A Deeply Grateful,

Outlander Anatomist

Photo creds: Starz, Netter’s Atlas of Human Anatomy, 4th ed., Clinically Oriented Anatomy, 5th ed., www.en.wikipedia.org (elephant)